An Approach to Sacroiliac Joint Pain (SIJ PAIN) – history, examination and investigations

Sacroiliac joint pain: how to recognize causes, tests, and treatments to relieve deep unilateral buttock pain and restore pelvic stability. Learn the signs of sacroiliac (SI) joint pain, sacroiliitis, and how to tell mechanical issues from inflammatory or infectious causes. This video explains typical symptoms—deep one-sided buttock pain often radiating to the lateral thigh or groin—common triggers (single-leg stance, stairs, twisting, pregnancy), and red flags that suggest discogenic or neurological problems. You’ll see practical bedside provocation tests (FABER/PATRICK, Gaenslen’s, thigh thrust, pelvic compression/distraction, sacral thrust) and why a cluster of positive tests points to the SI joint as the primary pain generator. Imaging and labs are demystified: when X-ray, MRI with STIR, CT, ESR/CRP, HLA-B27, or image-guided diagnostic injections are useful. Management strategies focus on the main value: getting you moving with less pain—education, activity modification, targeted physiotherapy for lumbopelvic stabilization and glute/core strengthening, analgesics and short-term NSAIDs, pelvic belts in pregnancy, and image-guided corticosteroid injections for focal refractory pain. Advanced options (radiofrequency ablation, sacroiliac fusion) are reserved for multidisciplinary, refractory cases. For inflammatory sacroiliitis, learn when rheumatology, biologics, and long-term anti-inflammatory strategies are indicated. Clear, evidence-informed guidance helps patients and clinicians identify causes, choose appropriate tests, and apply effective conservative and interventional treatments—watch to improve diagnosis and speed recovery.